Intake Form

Doherty Fultz Immigration

Intake Form

I understand that I am obliged to pay a consultation fee of $175.00 + HST per hour of consultation over phone or skype, or $225.00 + HST in person. I understand that in-person consultation fees must be paid at the time of appointment booking, and consultation fees paid are non-refundable for missed or cancelled appointments.

All information discussed or disclosed in the context of a consultation at Doherty Fultz Immigration is STRICTLY CONFIDENTIAL, and is bound by representative-client privilege. These terms and conditions shall be governed by the laws in effect in the Province of Ontario, Canada.

Please be advised that Anthony Doherty and Cassandra Fultz of Doherty Fultz Immigration are members in good standing of the Immigration Consultants of Canada Regulatory Council (ICCRC), and as such, are bound by its By-laws, Code of Professional Ethics, and associated Regulations. By signing this intake agreement, you acknowledge that any interaction with IRCC or CBSA undertaken by you without retaining an Doherty Fultz Immigration RCIC as a legal representative is done at your own risk, and Doherty Fultz Immigration accepts no responsibility for the outcome of any such interaction.

Full Name*

Gender*

Date of birth*

Highest level of education achieved*

Occupation*

Employer's name*

Street address*

City/Town*

Province*

Postal Code*

Nationality*

Country of Residence*

Status in Canada

Status Date Expiry (if applicable)

Do you ave a Spouse/Common-Law Partner?

No

Spouse

Common-Law Partner

Spouse/Partner's Name (if applicable)

Spouse/Partner's nationality

How long have you been married on in a common-law relationship?

Have you or your spouse ever been convicted of a criminal offence?

No

Yes

Please briefly describe your immigration matter so we can assist you*

How did you hear about DFI?

Referred by a friend or family member?

Returning client

Online reviews (Facebook, Google, Yelp, other review site)

Google or Bing

By typing my first and last name, I hereby certify that this document is legally executed by the person named herein as the Client, and that I understand and acknowledge all of the above information to be true, correct, and complete.*

Today's Date

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